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acne is characterised by 2 things…?
what are the main causes of acne? - disease process
- increased keratin causes obstruction of sebaceous glands results in comedone formation
- androgens induce sebaceous gland to produce more sebum
- the duct gets colonised with p-acnes due to altered environment
how can the severity of acne be graded?
- 1. clinical appearance
- 2. how many spots
- 3. scarring
- 4. how long has it been there for
- 5. how much is it affecting life
what is the most common type of acne?
which areas of the body does acne affect?
- (the comedogenic areas)
what is a comedone?
- plug of sebum and keratin over a hair follicle
- can be open = blackhead
- closed = whitehead (remains white as oxygen couldn't get in to oxidise it)
who does acne vulgaris affect more?
- adolescents - puberty
- can have familial tendency
why should acne be treated promptly?
to avoid scarring and post inflammatory pigmentation
what 4 aspects does acne treatment need to target?
- p acnes
what are the 3 general topical Rx for acne?
- benzoyl peroxide: kills microorganisms and dries skin
- antibiotics: kills organs and reduce inflame response
- topical retinoids: normalise desquamation + reduce inflame response
what are the 3 main categories of systemic Rx for acne?
what 4 ways can acne affect someone psychologicaly?
- low self esteem
- poor inter-personal relationships
what are the 2 main classifications of acne?
- mild, mod, severe
- comedonal, inflammatory, mixed
what is the 1st choice drug for comedonal acne?
- topical retinoids: vitamin A derivative that are anti-inflamm and comedolytic
- eg adapalene or tretinoin
how does benzoyl peroxide work?
- anti microbial
what is Rx of mild papular-pustular acne - ie INFLAMMATORY
- topical retinoids eg adapalene
- topical antimicrobial eg benzoyl peroxide or antibiotics eg erythromycin/clindamycin
what is Rx of moderate inflammatory acne?
- topical retinoid
- ORAL antibiotics eg tetracyclines - minocycline, lymecycline
what 2 things do you have to remember with tetracycline?
- absorption reduced by milk and antacids
- can cause photosensitivity so use at night
what is the alternative oral Rx for females with moderate acne?
- dianette - cyproterone acetate + oestradiol
- use if evidence of hyperandrogenism eg PCOS
what is Rx of severe acne?
ORAL isotretinoin - roaccutane
what are SE of oral isotretinoin?
- dry kin especially on the face
- dry eyes
- hoarse voice
- arthritis, myalgia
- psychiatric effects
what do you have to ensure when prescribing oral isotretinoin to a woman?
- ask if pregnant
- do pregnancy test
- must use both hormonal and barrier method of contraception
what is rosacea? features
skin disorder characterised by facial FLUSHING, persistent erythema, inflammatory papules, pustules, oedema, telangiectasia
what is rosacea associated with?
- rhinophyma after chronic - thick, hypertrophic nasal skin
what exacerbates rosacea?
- heat, exercise
- hot drinks/food, spicy food, alcohol
what is Rx of rosacea?
- avoid triggers
- avoid soaps and cleansers
- topical metronidazole
- azelaic acid cream - finacea